WO2015004519A1 - New modus of administration of iron, and new formulations adapted for the said goal - Google Patents
New modus of administration of iron, and new formulations adapted for the said goal Download PDFInfo
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- WO2015004519A1 WO2015004519A1 PCT/IB2014/001303 IB2014001303W WO2015004519A1 WO 2015004519 A1 WO2015004519 A1 WO 2015004519A1 IB 2014001303 W IB2014001303 W IB 2014001303W WO 2015004519 A1 WO2015004519 A1 WO 2015004519A1
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/555—Heterocyclic compounds containing heavy metals, e.g. hemin, hematin, melarsoprol
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
- A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
- A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K33/00—Medicinal preparations containing inorganic active ingredients
- A61K33/24—Heavy metals; Compounds thereof
- A61K33/26—Iron; Compounds thereof
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
- A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
- A61K47/36—Polysaccharides; Derivatives thereof, e.g. gums, starch, alginate, dextrin, hyaluronic acid, chitosan, inulin, agar or pectin
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
- A61K9/0056—Mouth soluble or dispersible forms; Suckable, eatable, chewable coherent forms; Forms rapidly disintegrating in the mouth; Lozenges; Lollipops; Bite capsules; Baked products; Baits or other oral forms for animals
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
- A61K9/006—Oral mucosa, e.g. mucoadhesive forms, sublingual droplets; Buccal patches or films; Buccal sprays
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/20—Pills, tablets, discs, rods
- A61K9/2004—Excipients; Inactive ingredients
- A61K9/2022—Organic macromolecular compounds
- A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
- A61K9/2059—Starch, including chemically or physically modified derivatives; Amylose; Amylopectin; Dextrin
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P3/00—Drugs for disorders of the metabolism
- A61P3/02—Nutrients, e.g. vitamins, minerals
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P7/00—Drugs for disorders of the blood or the extracellular fluid
- A61P7/06—Antianaemics
Definitions
- the present invention relates to a new modus and a new regimen of administration of divalent iron for hyposideremia therapy and to new formulations containing divalent iron compounds adapted to release the iron for intrabuccal absorption, preferably for sublingual absorption.
- Iron metabolism has the particularity that it is controlled by absorption rather than by excretion: iron is eliminated mainly by means of the loss of cells of the mucosae and of the skin (approximately 1 mg per day).
- the total pool of iron in our body is approximately 4,000 mg, of which a little over 2,000 is in erythrocytes and in their precursors and 1 ,600-1 ,800 mg are in the form of deposit, while the amount of iron that can be found in serum is approximately 4 mg.
- Divalent iron in the form of salts or complexes, is administered generally orally (i.e., for absorption at the gastrointestinal level), while trivalent iron is administered only in the form of a complex both orally (i.e., for adsorption at the gastrointestinal level) and parenterally.
- the absorbed iron is usually carried and deposited in iron-deficient cells by protein (transferrin is one of the main iron carriers); however, if the quantity of iron absorbed is such as to saturate transferrin (or if absorption is faster than the complexing rate of transferrin) and is such as to circulate in ionized form in the blood as trivalent iron, toxicity conditions can occur.
- This non transferrin bound excess manifests its toxicity by causing the formation of compounds based on reactive oxygen, such as the superoxide anion (02—), hydrogen peroxide (H202) or the hydroxyl radical ( ⁇ ), all of which are capable of damaging cells by oxidizing protein, lipids and DNA itself (Gutteridge J.M. Lipid peroxidation and antioxidants as biomarkers of tissue damage. Clin. Chem. 1995; 41 : 1819- 1828; Stadtman E.R., Berlett B.S. Reactive oxygen- mediated protein oxidation in aging and disease. Chem. Res. Toxicol.
- This toxicity of divalent iron can occur both in the adult and in the child, in which the outcome can even be fatal.
- the patient rapidly reaches a level of serum iron that is higher than desired, entering a state of hypersideremia; in these conditions, the patient is exposed to an oxidative stress which is due to high blood levels of iron [Al-Rashid, Rashid A, ( 1971 ) Clinical Toxicology, 4:4, 571-578; Witzleben C.L. and Buck B.E. (1971 ) Clinical Toxicology 4:4, 579-583; K.R. Reissmann and T.J. Coleman, (1955)10: 46-5 1].
- iron sulfate or other divalent iron salts Through the years there has been an important number of deaths due to hypersideremia in children after oral administration of iron sulfate or other divalent iron salts.
- Trivalent iron i.e., Fe(III), Fe3 + or Fe + H
- Trivalent iron can be absorbed only at extremely acid pH levels, distinctly lower than 2.0, since only in these conditions is it stable as a cation and does not precipitate.
- oral administration i.e., for absorption at the gastrointestinal level
- trivalent iron salts finds no application, since the pH close to neutrality of the duodenum-jejunum intestinal tract, which is the portion assigned to iron absorption, causes its precipitation, making its absorption impossible.
- trivalent Fe has instead been made possible by using complexing agents such as citrate anions, EDTA and others - or mono and disaccharides, which are able, again by complexing, to render soluble even trivalent Fe in the form of hydroxide oxide (FeOOH). Therefore, in these conditions the trivalent iron contained in the complexes cited above, by not precipitating at the level of the duodenum-jejunum tract, remains bioavailable for gastrointestinal absorption and is therefore usable for oral administration.
- complexing agents such as citrate anions, EDTA and others - or mono and disaccharides
- Fe+++ complexes administered orally, do not produce the side effects of Fe++ salts.
- An object of the present invention is therefore to provide compounds of iron and new formulations of iron that are not parenteral and allow an alternative to classic oral, i.e., gastrointestinal, administration, in the therapy of hyposideremia or of its more severe states, avoiding advantageously the drawbacks associated with gastrointestinal administration of salts of divalent Fe or of complexes of trivalent iron.
- facilitated treatment also becomes possible of anemic states in patients that do not tolerate oral therapy (i.e., by absorption at the gastrointestinal level), such as for example patients affected by chronic inflammatory bowel diseases (IBD) or by celiac disease, thus avoiding parenteral therapy.
- IBD chronic inflammatory bowel diseases
- a further object of the present invention is to provide new formulations of iron that are not parenteral and exhibit a reduced toxicity with respect to classic formulations of divalent iron that are administered orally.
- a further object of the present invention is to provide new formulations of divalent iron that are effective for the therapy of anemic states due to malabsorption of iron caused by celiac disease or chronic inflammatory bowel diseases or due to chronic sideropenic anemia caused by blood losses at lower dosage regimens than oral preparations (i.e., with gastrointestinal absorption) that are currently commercially available, thus lowering favorably the risk/benefit ratio of the therapy.
- US 4058621 relates generically to complexes of galacturonate or glucuronate that comprise iron for administration to mammals. However, US 4058621 does not describe the administration to human beings of divalent iron by means of the above cited complexes. Most of all, US 4058621 does not teach intrabuccal or sublingual administration and much less teaches this type of administration to reduce the onset of free iron with respect to gastrointestinal administration.
- US 405862 does not raise the problem of the toxicity of free iron and rather teaches to dose the active ingredient by providing a certain safety margin with respect to the oral LD50 (of iron(II) sulfate) according to the literature.
- oral LD50 of iron(II) sulfate
- US 4058621 considers formulations in chewing gum form as forms of oral administration (see also the comment below regarding chewable tablets).
- US 4058621 in fact contains no in vitro or in vivo exploration regarding intrabuccal administration, its effectiveness if any, and/or a possible (negative or positive) influence of the relationship between pharmacological activity and side effect that might arise from it. The doses reported by US 4058621 , therefore, are not described for intrabuccal administration.
- the Tot'hema preparation mentioned in Celeketic et al. "Treatment of iron-deficiency anemia with ferrous gluconate", Blood Reviews, Churchill Livingstone, Amsterdam, NL, vol. 21 , August 1 , 2007 page S I 17 is a drinkable solution that is marketed in vials comprising 50 mg of Fe.
- a chewable tablet is a pharmaceutical form for oral, i.e., gastrointestinal, administration.
- the chewable tablet in addition to the fact that it can be swallowed directly like a classic tablet, can be ingested easily even without water by the patient, in particular by children or geriatric patients, without having to swallow the entire tablet. Therefore, the chewable tablet, in the absence of other specific indications, does not necessarily produce an intrabuccal absorption. Most of all, in the absence of specific indications, the chewable tablet cannot produce a definite or repeatable transmucosal absorption in the buccal apparatus.
- US 2003/082107 relates to intrabuccal formulations proposed for a large quantity of active ingredients of entirely different chemical and pharmacological classes. While it mentions, among these, also ferrous sulfate, the latter is not indicated by US 2003/082107 as anti-anemic, but rather as an antidote, i.e., in order to contrast poisonings. US 2003/082107 also lacks any data (in vitro or in vivo) regarding the effectiveness of intrabuccal administration for any concrete active ingredient. Much less does US 2003/082 107 explore how intrabuccal administration might influence the relation between sought pharmacological effect and side effect for a given active ingredient.
- the present invention in a nonexclusive embodiment thereof, provides divalent iron compounds for use in hyposideremia therapy by administration through intrabuccal absorption in a patient, in which administration occurs with the indication to the patient to avoid swallowing the formulation containing the divalent iron compound and/or saliva for a period of time of at least 30 seconds after placing the formulation containing the divalent iron compound in the intrabuccal cavity, said use providing for the administration of divalent iron at doses comprised in an interval between 1 -90 mg of divalent Fe per day for a human patient in order to reduce, for an equal increase in transferrin saturation, the onset of free non transferrin bound iron with respect to gastrointestinal administration.
- the present invention provides formulations of divalent iron with intrabuccal absorption, in which the divalent iron compound is constituted preferably by a salt or a complex of divalent iron which is soluble at pharmaceutical acceptable pH values for administration through intrabuccal absorption, said formulation being preset in individual doses comprised in an interval ranging from 0.5 to 30 mg of divalent iron for use in hyposideremia therapy in a patient, in which therapy administration occurs with the indication to the patient to avoid swallowing the formulation containing the divalent iron compound and/or saliva for a period of time of at least 30 seconds after placing the formulation containing the divalent iron compound in the intrabuccal cavity, in order to reduce, for an equal increase in transferrin saturation, the onset of free non transferring bound iron with respect to gastrointestinal administration.
- administration through intrabuccal, preferably sublingual, absorption of a divalent iron compound according to the present invention allows to obtain in the patient an increase in transferrin saturation that is comparable to the one produced by gastrointestinal administration (i) at a dose that is reduced by at least 50%, and (ii) with an onset of non transferrin bound iron that is reduced at least by 75% with respect to gastrointestinal administration.
- use in the therapy of the most severe states of hyposideremia occurs by administration through intrabuccal absorption, preferably through sublingual absorption in a patient, said use providing for the administration of divalent iron at doses comprised in an interval from 1 0 to 90 mg of divalent Fe per day for a human patient, preferably 30 to 90 mg of divalent Fe per day for a human patient, more preferably 40 to 90 mg of divalent Fe per day for a human patient, even more preferably 45 to 90 mg of divalent Fe per day for a human patient.
- these doses are lower than the doses (with gastrointestinal administration) normally prescribed for the above cited severe hyposideremia states, and therefore the provision of these reduced doses is -on its own- an object of the present invention. Moreover, according to a further aspect of the present invention, these doses are used preferably to reduce, for an equal increase in transferrin saturation, the onset of free non transferrin bound iron with respect to gastrointestinal administration.
- the present invention provides divalent iron compounds for use in the therapy of relapsing anemic states, which have been treated previously with gastrointestinal therapy with compounds of divalent or trivalent iron or have been treated previously with parenteral therapy with trivalent iron compounds, said use providing for administration through intrabuccal absorption, preferably sublingual absorption, of the divalent iron compound to the patient.
- the present invention provides an anti- hyposideremic medical composition with release for intrabuccal absorption, preferably for sublingual absorption, comprising divalent iron for use in therapy with doses comprised in an interval between 1-90 mg of divalent Fe per day for a human patient, preferably 1 to 60 mg of divalent Fe per day for a human patient, more preferably from 4 to 40 mg of divalent Fe per day for a human patient, even more preferably from 5 to 30 mg of divalent Fe per day for a human patient.
- said anti-hyposideremic medicinal composition based on divalent iron for intrabuccal absorption, preferably for sublingual absorption is preset in individual doses comprised in an interval from 0.5 to 30 mg of divalent Fe, preferably from 3 to 20 mg of bivalent Fe, more preferably 3 to 10 mg of divalent Fe. Further embodiments and preferred variations thereof are described hereinafter.
- FIG. 1 is a schematic view of the Franz cell as used in the in vitro experiments described herein.
- Figure 2 shows permeation charts of solutions of Fe++ ascorbate with and without ascorbic acid obtained in the Franz cell.
- the vertical axis plots the permeated divalent Fe (in micrograms per square centimeter of membrane), while the horizontal axis plots time (in hours).
- the curve recorded with 50 mg/ml of divalent Fe ascorbate and in the presence of ascorbic acid reaches a value above 150 micrograms/square centimeter after 3 hours and a value of approximately 200 micrograms/square centimeter after 4 hours (see pale blue squares).
- the curve recorded with 350 mg/ml of divalent Fe ascorbate and in the presence of ascorbic acid reaches a value just below 150 micrograms/square centimeter after 3 hours and a value of approximately 200 micrograms/square centimeter after 4 hours (see purple squares).
- the curve recorded with 400 mg/ml of divalent Fe ascorbate and in the absence of ascorbic acid reaches a value just above 100 micrograms/square centimeter after 3 hours and a value of approximately 150 micrograms/square centimeter after 6 hours (see purple diamonds).
- the curve recorded with 600 mg/ml of divalent Fe ascorbate and in the absence of ascorbic acid reaches a value just above 100 micrograms/square centimeter after 3 hours and a value of approximately 125 micrograms/square centimeter after 6 hours (see red squares).
- the curve recorded with 1000 mg/ml of divalent Fe ascorbate and in the absence of ascorbic acid reaches a value of approximately 50 micrograms/square centimeter after 3 hours and a value of approximately 100 micrograms/square centimeter after 5 hours (see green triangles).
- Figure 3 is a permeation chart of the solution of ferric citrate (Fe+++) obtained in the Franz cell.
- the vertical axis plots the permeated trivalent Fe (in micrograms per square centimeter of membrane), while the horizontal axis plots time (in hours). After 4 hours, a little under 1 1 micrograms of trivalent iron per square centimeter have permeated.
- Figure 4 shows the saturation of transferrin (as a percentage, on the vertical axis on the left) and free non transferrin bound iron (NTBI) (in micromoles/liter on the vertical axis on the right) over time (minutes) after sublingual administration of 30 mg of divalent Fe according to the present invention.
- transferrin as a percentage, on the vertical axis on the left
- NTBI free non transferrin bound iron
- Figure 5 plots transferrin saturation (as a percentage, on the vertical axis on the right) and free non-transferrin bound iron (NTBI) in micromoles/liter on the vertical axis on the left) over time (hours) after oral (gastrointestinal) administration of 100 mg of divalent Fe according to Dresow et al, Biometals (2008), 21, 273-276.
- the inventors of the present application have found surprisingly that the mentioned aim and objects of the invention are achieved by providing new formulations for intrabuccal absorption, preferably sublingual absorption, of divalent iron compounds.
- Intrabuccal or preferably sublingual administration occurs by administration of an adapted formulation applied in the oral cavity, preferably under the tongue of the patient, with an indication to the patient to avoid swallowing the formulation containing the divalent iron compound and/or saliva for a period of time of at least 30 seconds, preferably at least one minute, more preferably at least two minutes, even more preferably at least four minutes after placing the formulation containing the divalent iron compound in the intrabuccal cavity, preferably under the tongue.
- Compounds of divalent iron that can be used for the purposes of the present invention are understood to be all compounds, including salts and complexes, with pharmaceutically acceptable anions, of divalent iron that are soluble at the physiological pH of the site of administration, i.e., at the intrabuccal pH of a human patient, or at values of pH that can be tolerated in the intrabuccal administration site, such as for example pH 2.0-8.0, preferably pH 2.0-6.5, more preferably pH 2.5-4.5.
- divalent iron compounds are therefore salts and complexes of divalent iron already currently used in classic oral therapy, including, for example, the group consisting of ferrous sulfate, ferrous citrate, ferrous ascorbate, ferrous fumarate, ferrous glycinate, ferrous gluconate and others.
- divalent compounds considered by the present invention preference is given to Fe++ ascorbate.
- intrabuccal formulations is understood to reference all formulations preset and indicated to release the active ingredient so as to allow its absorption through the intrabuccal mucosa, preferably through the sublingual mucosa, such as, merely by way of example: intrabuccal tablets, sublingual tablets, so-called oral drug strips (i.e., intrabuccal or sublingual films), so-called wafers (i.e., intrabuccal or sublingual flat elements), granulated or powdered material, sprays, foams, gels or intrabuccal paste.
- the tablets, strips (films) and wafers (flat elements) are prepared in film form.
- “Film form” means that the tablets, films or flat elements according to the invention, differently for example from traditional tablets, are characterized by a reduced thickness and are preferably flexible. Moreover, they are preferably preset to adapt, after absorbing humidity, to the oral mucosa, such as for example the palate or the sublingual or gingival region.
- the total thickness of the film forms amounts preferably to 0.05 to 3 mm, more preferably 0.1 to 1 mm, and even more preferably to 0. 1 to 0.5 mm.
- the film forms can have a round, oval, triangular, quadrangular or multi-angular area shape. Their area amounts preferably to 0.5 to 20 cm 2 , preferably 1 to 10 cm 2 .
- the film forms may have mucoadhesiveness characteristics indeed to allow correct absorption in the sublingual or palate region and can release the divalent iron completely with times that can vary from a few seconds to a few minutes.
- the solid formulations according to the present invention are characterized in that they break down rapidly in aqueous environments, preferably in saliva, preferably within 10 seconds to 5 minutes, more preferably within 30 seconds to 3 minutes, even more preferably within 1 and 2 minutes, releasing the entire divalent iron compound.
- the film forms to be applied/stuck to the palate or to the sublingual region which can comprise both rapid-breakdown tablets (so-called “fast-melt” tablets) and films or strips with immediate or delayed release, can be administered in a simple, inconspicuous and safe manner, without further addition of liquids (as occurs instead for tablets to be swallowed), thus achieving excellent patient compliance.
- the above cited divalent iron formulations are in fact believed to be suitable to ensure an intrabuccal absorption, preferably sublingual absorption, of divalent iron compounds that is repeatable, regular in its quantity and required time, without resorting to high doses.
- hyposideremia is determined by an iron deficiency, such as anemia associated with chronic or acute blood loss, pregnancy, childbirth, infant growth, psychomotor development, severe uterine hemorrhages, menstruations, chronic relapsing hemoptysis, parasite infections, chronic kidney diseases and dialysis, surgical procedures or acute traumas, chronic ingestion of alcohol or steroids, chronic ingestion of NSA (nonsteroidal anti-inflammatory agents) or chronic ingestion of erythropoiesis stimulating agents.
- an iron deficiency such as anemia associated with chronic or acute blood loss, pregnancy, childbirth, infant growth, psychomotor development, severe uterine hemorrhages, menstruations, chronic relapsing hemoptysis, parasite infections, chronic kidney diseases and dialysis, surgical procedures or acute traumas, chronic ingestion of alcohol or steroids, chronic ingestion of NSA (nonsteroidal anti-inflammatory agents) or chronic ingestion of erythropoiesis stimulating agents.
- hyposideremia can be an anemia associated with other diseases, such as rheumatoid arthritis, cancer, Hodgkin's leukemia, non-Hodgkin's leukemia, anticancer chemotherapy, bowel inflammation (IBD), ulcerative colitis, thyroiditis, hepatitis, systemic lupus erythematosus, rheumatic polymyalgia, scleroderma, connective tissue diseases, Sojgren's syndrome, congestive heart failure/cardiomyopathy, or geriatric idiopathic anemia.
- hyposideremia can be due to disorders in iron absorption, such as for example anemias associated with Crohn's disease, gastric surgery, ingestions of drugs that inhibit iron absorption or chronic ingestion of calcium.
- Anti-hyposideremic medicinal compositions according to the present invention are preferably indicated for administration through intrabuccal, preferably sublingual, absorption of divalent iron with doses comprised in an interval from 1 to 90 mg of divalent Fe per day for a human patient, preferably 1 to 60 mg of divalent Fe per day for a human patient, more preferably 4 to 40 mg of divalent Fe per day for a human patient, even more preferably 5 to 30 mg of divalent Fe per day for a human patient, with the aim of restoring biological levels in the patient affected by hyposideremia, in order to reduce, for an equal increase in transferrin saturation, the onset of free non-transferrin bound iron with respect to gastrointestinal administration.
- the doses cited above can be modified preferably in severe cases of hyposideremia, such as (i) malabsorption of iron due to celiac disease or chronic inflammatory bowel diseases or (ii) of chronic sideropenic anemia due to blood losses.
- hyposideremia such as (i) malabsorption of iron due to celiac disease or chronic inflammatory bowel diseases or (ii) of chronic sideropenic anemia due to blood losses.
- Chronic sideropenic anemia due to blood losses is linked to the following phenomena:
- the doses are preferably comprised in an interval from 10 to 90 mg of divalent Fe per day for a human patient, preferably 30 to 90 mg of divalent Fe per day for a human patient, more preferably 40 to 90 mg of divalent Fe per day for a human patient, even more preferably 45 to 90 mg of divalent Fe per day for a human patient. Particular preference is given to an interval ranging from 45 to 65 mg of divalent Fe per day for a human patient.
- the anti-hyposideremic medicinal compositions according to the present invention are also indicated in the therapy of relapsing anemic states treated previously with gastrointestinal therapy with compounds of divalent or trivalent iron, or treated previously with parenteral therapy with trivalent iron compounds. In these cases, the doses can be reduced with respect to the previous therapy.
- Therapy of relapsing anemic states can occur preferably at doses comprised in an interval from 1 to 90 mg of divalent Fe per day for a human patient, preferably 1 to 60 mg of divalent Fe per day for a human patient, more preferably 4 to 40 mg of divalent Fe per day for a human patient, even more preferably 5 to 30 mg of divalent Fe per day for a human patient, with the purpose of restoring biological levels in the patient affected by relapsing anemic states.
- the doses applied are generally higher, preferably comprised in an interval from 10 to 90 mg of divalent Fe per day for a human patient, preferably 30 to 90 mg of divalent Fe per day for a human patient, more preferably 40 to 90 mg of divalent Fe per day for a human patient, even more preferably 45 to 90 mg of divalent Fe per day for a human patient.
- a dose comprised in an interval from 45 to 65 mg of divalent Fe per day for a human patient.
- the anti-hyposideremic formulations with intrabuccal absorption, preferably with sublingual absorption, discovered by the inventors can be prepared by including buffering excipients and/or reducing excipients, with the aim of ensuring the solubility of the administered divalent compounds, preferably in the sublingual region. In this manner it is not necessary to administer high doses of drug to appreciate an effective absorption thereof, differently from what can occur in classic oral therapy.
- concentration would appear to influence sublingual absorption of divalent iron in some cases in an inversely proportional manner, while the pH of the solution being considered, preferably maintained by means of the presence of buffering agents and/or the presence of reducing agents (antioxidants), influences most of all the stability of the ferrous ion.
- the Fe++ compounds used in the formulations according to the present invention are compounds in which the iron is in its ionic form, which is soluble practically at all pH values comprised between 2.0 and 8.0, and therefore can be formulated and absorbed more easily for the intrabuccal pathway, preferably sublingual pathway.
- intrabuccal administration allows to avoid the side effects due to contact of divalent iron with gastric mucosa; moreover, by using relatively low daily doses, which can be administered preferably by means of reduced single doses of divalent iron in the context of anti-hyposideremic therapy, one avoids high absorption peaks, with which toxicity due to saturation of circulating transferrin is often correlated.
- divalent iron once absorbed through the sublingual pathway, rapidly makes contact with blood proteins, including ceruloplasmin or ferroxidase (Osaki, S., Kinetic Studies of Ferrous Ion Oxidation with Crystalline Human Ferroxidase (Ceruloplasmin). J. Biol.
- sublingual administration of divalent Fe according to the present invention allows to achieve an appropriate increase in the percentage of transferrin saturation (comparable to that obtained through the gastrointestinal pathway), using reduced doses (for example doses reduced by at least 50%, preferably at least 60%, with respect to the classic oral administration of the same compound of divalent iron), achieving, for example two hours after administration, substantially an equal increase in saturation accompanied at the same time by a reduction of the correlated risk (the free non transferrin bound iron is reduced by at least 75%, preferably at least 80%, more preferably at least 90%, with respect to classic oral administration of the same divalent iron compound), thus improving significantly the risk/benefit ratio linked to hyposideremia therapy.
- reduced doses for example doses reduced by at least 50%, preferably at least 60%, with respect to the classic oral administration of the same compound of divalent iron
- substantially an equal increase in saturation accompanied at the same time by a reduction of the correlated risk the free non transferrin bound iron is reduced by at least 75%, preferably at least 80%, more preferably
- the divalent iron preferably at the optimum pH for absorption with the addition of adapted buffer systems.
- This can occur by including in the formulation pharmacologically acceptable buffer systems in a quantity suitable to obtain a pH between 2.0 and 6.5, preferably between 2.5 and 4.5, in the oral cavity of the patient during the initial step after the placement of the formulation in the oral cavity, preferably during 10 seconds to 5 minutes, more preferably 15 seconds to 3 minutes, even more preferably 20 seconds to 2 minutes.
- formulations with intrabuccal or preferably sublingual absorption are obtained which are preset in individual doses ranging from 0.5 to 30 mg of divalent Fe, preferably ranging from 3 to 20 mg of divalent Fe, more preferably ranging from 3 to 10 mg of divalent Fe for use in hyposideremia therapy in a patient.
- the formulations according to the present invention can also comprise additional active ingredients, such as for example folic acid.
- the mucosa was immersed in distilled water at 60°C for 2 minutes and then the epithelium was removed from the underlying tissue with the aid of a spatula.
- the tissues thus prepared were stored at -20°C until the time of use, when they were thawed to room temperature before being mounted on the vertical diffusion cells of the Franz type, a schematic view of which is shown in Figure 1.
- the esophageal epithelium was placed on a regenerated cellulose filter (pore diameter 0.45 ⁇ ) with the luminal side facing up, and mounted between the donor and receptor compartments of the Franz cells.
- the filter only acts as a support and does not interfere with permeation of the active ingredient.
- the exposed surface was 0.6 cm 2 .
- the receptor compartment was filled with approximately 4 ml of physiological solution (0.9% NaCl w/v) and kept under constant magnetic agitation for the entire duration of the experiment.
- the entire system was thermostat-controlled at 37°C.
- Sampling of the receptor compartment was performed by drawing 200 ⁇ of receptor solution, which were replaced immediately with an equal volume of fresh physiological solution. The samples were taken at preset time intervals, specifically at 0, 1 , 2, 3, 4, 5 and 6 hours.
- the complex of FeOOH with a maltodextrin (Fe +++ -polymaltose with molecular weight of 300,000 Da), measured in the Franz cell as in example 1 , was used as Fe +++ .
- 4 g of powder were suspended in 10 ml of physiological solution. The suspension was left under magnetic agitation for 15 hours, at the end of which it was filtered with regenerated cellulose filters (pore diameter 0.45 ⁇ ).
- the Fe +++ polymaltose concentration that corresponded to solubility was found to be 270.23 ⁇ 14.47 mg/ml.
- Fe +++ citrate Another compound of Fe +++ used in the absorption tests as in example 1 was ferric citrate. An excess of powder was suspended in 10 ml of physiological solution. The suspension was left under magnetic agitation for 15 hours, at the end of which it was filtered with regenerated cellulose filters (pore diameter 0.45 ⁇ ⁇ ⁇ ). The concentration of Fe +++ citrate that corresponded to solubility was found to be 280 mg/ml. The pH of the solution was 1.2. The absorption chart is shown in Figure 3.
- Fe+++ absorption occurs exclusively at pH values lower than 2; at higher pH values, Fe+++ is no longer available because it precipitates.
- Alternative sublingual powder content of 1 sachet with powder mix: Fe(II) ascorbate 40 mg (equal to 5 mg of Fe ++ ); fructose 60 mg; ascorbic acid 10 mg; lemon fragrance 5 mg.
- the patients participating in the clinical study were administered while fasting a quantity of 30 mg of Fe2+ in sublingual formulation, divided into six sachets, taken immediately one after the other with the indication to avoid swallowing the formulation and/or saliva for at least 4 minutes.
- Blood samples were taken 24 and 22 hours prior to administration as well as upon administration (time 0.0) and subsequently at times 0.033 (2 minutes), 0.10 (6 minutes); 0.20 (12 minutes); 0.33 (20 minutes); 0.50 (30 minutes); 0.75 (45 minutes); 1.00 (60 minutes); 1.25 (1 hour 15 minutes); 1.50 (1 hour 30 minutes); 1.75 ( 1 hour 45 minutes) and 2.00 (2 hours).
- Free iron by ultrafiltration measured in micromoles/liter ( NTBI) (ICP-MS) Total iron binding capacity (TIBC) measured in micrograms/dl (column separation, Vitros analyzer) Transferrin saturation (PTS) measured in %
- Serum iron measured in micrograms/dl, colorimetric method (Vitros analyzer)
- Intrabuccal administration, preferably sublingual administration, of Fe2+ according to the present invention therefore allows to saturate transferrin, using reduced doses (with respect to classic oral administration), achieving an equal effectiveness of saturation accompanied at the same time by a conspicuous reduction in the correlated risk, thus improving significantly the risk/benefit ratio of the administration of divalent iron compared with its classic oral (gastrointestinal) administration.
- a divalent iron compound for use in hyposideremia therapy by administration through intrabuccal absorption, preferably through sublingual absorption in a patient said use providing for the administration of divalent iron at doses comprised in an interval from 1 to 90 mg of divalent Fe per day for a human patient, preferably 1 to 60 mg of divalent Fe per day for a human patient, more preferably 4 to 40 mg of divalent Fe per day for a human patient, even more preferably 5 to 30 mg of divalent Fe per day for a human patient, to reduce, for an equal increment in transferrin saturation, the onset of free non transferrin bound iron with respect to gastrointestinal administration.
- a divalent iron compound for use in the therapy of iron malabsorption due to celiac disease or chronic inflammatory bowel diseases by administration through intrabuccal absorption, preferably through sublingual absorption in a patient, said use providing for the administration of divalent iron at doses comprised in an interval from 10 to 90 mg of divalent Fe per day for a human patient, preferably 30 to 90 mg of divalent Fe per day for a human patient, more preferably 40 to 90 mg of divalent Fe per day for a human patient, even more preferably 45 to 90 mg of divalent Fe per day for a human patient.
- a divalent iron compound according to the second embodiment for use in the therapy of iron malabsorption due to celiac disease or chronic inflammatory bowel diseases by administration through intrabuccal absorption, preferably through sublingual absorption in a patient, said use providing for the administration of divalent iron at doses comprised in an interval from 45 to 65 mg of divalent Fe per day for a human patient.
- a divalent iron compound for use in therapy of chronic sideropenic anemia caused by blood losses by administration through intrabuccal absorption, preferably through sublingual absorption in a patient, said use providing for the administration of divalent iron at doses comprised in an interval from 10 to 90 mg of divalent Fe per day for a human patient, preferably 30 to 90 mg of divalent Fe per day for a human patient, more preferably 40 to 90 mg of divalent Fe per day for a human patient, even more preferably 45 to 90 mg of divalent Fe per day for a human patient.
- a divalent iron compound according to the fourth embodiment for use in therapy of chronic sideropenic anemia caused by blood losses by administration through intrabuccal absorption, preferably through sublingual absorption in a patient, said use providing for the administration of divalent iron at doses comprised in an interval from 45 to 65 mg of divalent Fe per day for a human patient.
- a divalent iron compound according to the sixth embodiment for use in therapy of relapsing anemic states treated previously with gastrointestinal therapy using divalent or trivalent iron compounds or treated previously with parenteral therapy using trivalent iron compounds, said use providing for administration through intrabuccal absorption, preferably through sublingual absorption to the patient of divalent iron at doses comprised in an interval from 1 to 90 mg of divalent Fe per day for a human patient, preferably 1 to 60 mg of divalent Fe per day for a human patient, more preferably 4 to 40 mg of divalent Fe per day for a human patient, even more preferably 5 to 30 mg of divalent Fe per day for a human patient.
- a divalent iron compound for use in therapy of relapsing anemic states due to chronic sideropenic anemia caused by blood losses or of relapsing anemic states caused by iron malabsorption due to celiac disease or chronic inflammatory bowel diseases and treated previously with gastrointestinal therapy using divalent or trivalent iron compounds or treated previously with parenteral therapy using trivalent iron compounds, said use providing for administration through intrabuccal absorption, preferably through sublingual absorption to the patient of divalent iron at doses comprised in an interval from 10 to 90 mg of divalent Fe per day for a human patient, preferably 30 to 90 mg of divalent Fe per day for a human patient, more preferably 40 to 90 mg of divalent Fe per day for a human patient, even more preferably 45 to 90 mg of divalent Fe per day for a human patient.
- a divalent iron compound according to the eighth embodiment for use in therapy of relapsing anemic states due to chronic sideropenic anemia caused by blood losses or of relapsing anemic states caused by iron malabsorption due to celiac disease or chronic inflammatory bowel diseases and treated previously with gastrointestinal therapy using divalent or trivalent iron compounds or treated previously with parenteral therapy using trivalent iron compounds, said use providing for administration through intrabuccal absorption, preferably through sublingual absorption to the patient of divalent iron at doses comprised in an interval from 45 to 65 mg of divalent Fe per day for a human patient.
- a divalent iron compound according to one or more of the first to ninth embodiments its use providing for a therapeutic regimen of 1 -6, preferably 1 -3 single administrations per day to yield the daily doses according to the first embodiment to the ninth embodiment.
- a divalent iron compound according to the eleventh embodiment for use according to one or more of the first to eleventh embodiments, wherein administration occurs with the indication to the patient to avoid swallowing the formulation that contains the divalent iron compound and/or saliva for a period of time of at least 30 seconds, preferably at least one minute, more preferably at least two minutes, even more preferably at least four minutes after placing the formulation containing the divalent iron compound in the intrabuccal cavity, preferably under the tongue.
- a divalent iron formulation with intrabuccal absorption, preferably with sublingual absorption, prepared in single doses comprised in an interval from 0.5 to 30 mg of divalent Fe, preferably 3 to 20 mg of divalent Fe, more preferably 3 to 10 mg of divalent Fe for use in hyposideremia therapy in a patient, in order to reduce, for an equal increment in transferrin saturation, the onset of free non transferrin bound iron with respect to gastrointestinal administration.
- a divalent iron formulation according to the thirteenth embodiment for use in therapy of iron malabsorption due to celiac disease or chronic inflammatory bowel diseases, of chronic sideropenic anemia due to blood losses or of relapsing anemic states treated previously with gastrointestinal therapy with divalent or trivalent iron compounds or treated previously with parenteral therapy using trivalent iron compounds.
- a formulation according to the thirteenth or fourteenth embodiment in a form of administration selected from the group constituted by intrabuccal tablets, sublingual tablets, oral drug strips (i.e., intrabuccal or sublingual films), wafers (i.e., intrabuccal or sublingual flat elements), granulated or powdered material, sprays, foams, gels or intrabuccal paste.
- intrabuccal tablets, sublingual tablets, oral drug strips (i.e., intrabuccal or sublingual films) or wafers (i.e., intrabuccal or sublingual flat elements) have a film-like shape, in particular have a total thickness from 0.05 to 3 mm, preferably 0.1 to 1 mm, even more preferably 0.1 to 0.5 mm, and an area of preferably 0.5 to 20 cm2, preferably 1 to 10 cm2.
- a formulation according to one or more of the thirteenth to twentieth embodiments comprising buffering and/or reducing excipients, preferably ascorbic acid/ascorbate, in an amount adapted to obtain a pH between 2.0 and 6.5, preferably between 2.5 and 4.5 in the oral cavity of the patient.
- buffering and/or reducing excipients preferably ascorbic acid/ascorbate
- a formulation according to one or more of the thirteenth to twenty-first embodiments comprising at least one polymeric phase that constitutes 10-90% (w/w), preferably 20-70% (w/w), more preferably 20-50% (w/w) of the entire formulation.
- a formulation according to one or more of the thirteenth to twenty- second embodiments characterized in that it is mucoadhesive or exhibits at least one mucoadhesive surface.
- a solid formulation according to one or more of the thirteenth to twenty-third embodiments characterized in that it breaks down rapidly in aqueous environments, preferably in saliva, preferably within 10 seconds to 5 minutes, more preferably within 30 seconds to 3 minutes, even more preferably within 1 minute to 2 minutes, releasing the entire divalent iron compound.
- a formulation according to one or more of the thirteenth to twenty- fourth embodiments characterized in that the formulation comprises an additional active ingredient, for example folic acid.
Abstract
Description
Claims
Priority Applications (8)
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MX2016000304A MX361663B (en) | 2013-07-09 | 2014-07-09 | New modus of administration of iron, and new formulations adapted for the said goal. |
JP2016524902A JP6347832B2 (en) | 2013-07-09 | 2014-07-09 | New methods of iron administration and new formulations suitable for this purpose |
US14/903,814 US10543216B2 (en) | 2013-07-09 | 2014-07-09 | Modus of administration of iron, and new formulations adapted for the said goal |
RU2016103912A RU2016103912A (en) | 2013-07-09 | 2014-07-09 | A NEW METHOD OF APPLICATION OF IRON AND NEW COMPOSITIONS ADAPTED FOR THE SPECIFIED PURPOSE |
EP14780547.7A EP3019239B1 (en) | 2013-07-09 | 2014-07-09 | New modus of administration of iron, and new formulations adapted for the said goal |
CN201480039686.3A CN105377370B (en) | 2013-07-09 | 2014-07-09 | The new administration mode of iron and novel formulation suitable for the target |
ES14780547.7T ES2659830T3 (en) | 2013-07-09 | 2014-07-09 | New mode of iron administration and new formulations adapted for this purpose |
CA2917456A CA2917456A1 (en) | 2013-07-09 | 2014-07-09 | New modus of administration of iron, and new formulations adapted for the said goal |
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ITMI2013A001147 | 2013-07-09 | ||
IT001147A ITMI20131147A1 (en) | 2013-07-09 | 2013-07-09 | NEW WAY OF ADMINISTRATION OF THE IRON, AND NEW FORMULATIONS SUITABLE FOR THIS PURPOSE. |
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EP (1) | EP3019239B1 (en) |
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JP6999175B2 (en) | 2018-07-31 | 2022-02-04 | 株式会社東洋新薬 | Oral composition |
CN109010364A (en) * | 2018-09-12 | 2018-12-18 | 仲恺农业工程学院 | A kind of ferrous bisglycinate chelate enteric solubility sustained release pellet and preparation method being coated structure |
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US20030082107A1 (en) | 1997-10-01 | 2003-05-01 | Dugger Harry A. | Buccal, polar and non-polar spray or capsule containing drugs for treating an infectious disease or cancer |
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US4058624A (en) | 1976-05-14 | 1977-11-15 | Merck & Co., Inc. | Broad spectrum antibacterial compositions containing tris (hydroxymethyl)-aminomethane and diphenyl and loweralkyl substituted diphenyl polyamines |
EP0208362A1 (en) | 1985-06-28 | 1987-01-14 | The Procter & Gamble Company | Dietary supplements containing iron and enterically coated calcium |
US7090862B2 (en) * | 2001-03-30 | 2006-08-15 | Abbott Laboratories | Method of improving the antioxidant status of an infant |
US20050063918A1 (en) | 2003-09-19 | 2005-03-24 | Unilever Home & Personal Care Usa, Division Of Conopco, Inc. | Oral composition |
US7585527B2 (en) * | 2005-09-19 | 2009-09-08 | Bala Venkataraman | Composition and method for treating iron deficiency anemia |
FR2899476B1 (en) | 2006-04-11 | 2008-07-04 | Assist Publ Hopitaux De Paris | ASSOCIATION OF MAZINDOL IN THE TREATMENT OF DEFICIT ATTENTION / HYPERACTIVITY |
BRPI0822397A2 (en) | 2008-03-28 | 2014-10-07 | Chyna Llc | USE OF FERRITINE TO TREAT IRON DEFICIENCY DISORDERS |
EP2288268A1 (en) | 2008-05-21 | 2011-03-02 | Stokely-Van Camp, Inc. | Milk-based recovery beverage |
WO2012092305A2 (en) * | 2010-12-27 | 2012-07-05 | Incube Labs, Llc | Nanonized iron compositions and methods of use thereof |
JP2016535794A (en) * | 2013-11-11 | 2016-11-17 | インパックス ラボラトリーズ,インコーポレーテッド | Rapidly disintegrating preparations and methods of use |
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RU2016103912A3 (en) | 2018-05-07 |
CN105377370B (en) | 2019-06-18 |
MX2016000304A (en) | 2016-08-08 |
RU2016103912A (en) | 2017-08-14 |
US10543216B2 (en) | 2020-01-28 |
JP6347832B2 (en) | 2018-06-27 |
CN105377370A (en) | 2016-03-02 |
US20160151384A1 (en) | 2016-06-02 |
EP3019239A1 (en) | 2016-05-18 |
CA2917456A1 (en) | 2015-01-15 |
MX361663B (en) | 2018-12-13 |
ES2659830T3 (en) | 2018-03-19 |
JP2016523954A (en) | 2016-08-12 |
ITMI20131147A1 (en) | 2015-01-10 |
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